- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,585.78 / $22,387.21
| Professional | | $6,309.57 | $7,585.78 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $28,840.32 / $33,884.42
| Facility | | $21,379.62 | $28,840.32 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,585.78 / $15,488.17
| Professional | | $5,754.40 | $7,585.78 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $9,332.54
| Facility | | $8,317.64 | $8,317.64 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $9,332.54
| Professional | | $6,918.31 | $6,918.31 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $10,964.78 / $19,498.45
| Facility | | $9,549.93 | $10,964.78 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,760.83 / $8,912.51 / $12,022.64
| Professional | | $6,760.83 | $8,912.51 | $12,022.64 |